Pyelonephritis + T2DM

Question 1

A 48 year old woman with type 2 diabetes presents with fever and loin pain. How would you assess and manage her?

Answer 1

Impression
Given clinical symptoms, initially concerned about pyelonephritis with subsequent sepsis. Other important DDx to consider include ruptured ectopic pregnancy, ovarian torsion. May also be a simple cystitis.

Goals

• delineate underlying aetiology of symptomatology, screen for signs of septic shock
• initiate appropriate initial therapy and prevent complications
• treat underlying co-morbid conditions and reduce risk of recurrence

Question 2

Pyelonephritis - Assessment

Answer 2

Assessment
- Given fevers, would take an A to E approach to assess for signs of septic shock and haemodynamic instability initial assessment and management of this patient

A - patent, maintaining
B - RR, sats
C - 2xIVC, BP monitoring
- Fluid resus if shocked (assess balance, haemodynamic stability) 
-